13 GENERAL INTRODUCTION 1 home or long-term care situation. However, not all patients are eligible to participate in rehabilitation practices after hospital discharge. Some can participate in dedicated programs, like the cardiac rehabilitation, but others have to arrange aftercare services for themselves.37 Keeping in mind the complexity of recovery, the lack of aftercare options for ICU-survivors is remarkable and undesirable. However, implementation of aftercare services is troublesome and their specific effects are still unclear.38,39 INNOVATION IN ICU-REHABILITATION Although the ICU is rarely the end station in the patient journey, it is essential that researchers, medical professionals and policy makers collaborate on improving aftercare services to reduce long-term health deficits in patients and informal caregivers after critical illness. More research is needed to specifically identify patients at risk of impaired recovery and in need of additional (long-term) care. One of the key factors in this search is finding new and innovative ways to acquire adequate information on the patient’s pre-ICU status. Additionally, investigating areas of improvement during and after ICU-admission to facilitate meaningful recovery, e.g. nutritional intake, can provide valuable targets for future intervention studies to set up interdisciplinary aftercare trajectories. Finally, using smart technology and eHealth can assure Figure 3. Barriers to nutritional adequacy in ICU-survivors (adapted from Ridley et al. 2020). Clinical barriers Communication issues Premature enteral feeding tube removal Insufficient patient handover Reduced staff ratios on ward Knowledge deficits System barriers Food service rigidity Protected mealtimes Patient barriers Poor appetite Hormone disturbances Disrupted sleep Lack of time awareness Swallowing disorders Gastrointestinal distrurbances
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